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House passes measure regulating ‘surprise’ medical bills

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Georgia Capitol

Georgia residents may see protections against so-called “surprise” medical bills after the House passed a measure Monday that regulates the practice.

Sen. Chuck Hufstetler, R-Rome, is also pushing similar legislation in his chamber with bipartisan support.

“Two out of three of you will get a surprise bill within the next two years,” Rep. Richard H. Smith, R-Columbus, said before his House Bill 678 passed in a vote of 164 to 1.

Surprise or balance bills come when a service is performed at an in-network hospital by a contract provider and the patient is billed for the difference between what his insurance company covers and the contractor’s fee.

“You’ve done everything right, or so you believe ... (But) some healthcare providers are not in the insurance network and they can charge you whatever they want,” Smith said. “In some cases it’s 10 to 12 times higher than in-network.”

HB 678 offers protections for scheduled procedures.

If the patient asks in advance, hospitals and healthcare facilities would have to disclose all the providers, their fees, if they’re in-network and the amount insurance will cover. It also requires balance bills to be submitted within 90 days and provides a dispute resolution process.

Smith chairs the House Insurance Committee. Rep. Eddie Lumsden, R-Armuchee, was among its members who voted to send the measure for a full chamber vote.

Lumsden and Floyd County’s other delegates — Reps. Katie Dempsey, R-Rome, and Christian Coomer, R-Cartersville — all voted in favor.

The legislation is a compromise from bills submitted last session that set more stringent requirements for physicians and pricing. Opponents voiced concern about forcing them to participate or placing more responsibility on the hospitals.

Redmond Regional Medical Center “encourages” its contract physicians to join its insurance networks but does not require it, hospital spokeswoman Andrea Pitts said at the time.

All Floyd Medical Center contract physicians must be part of the Cigna network, spokesman Rick Sheerin said during the last push, and they’re “strongly encouraged” to participate in the others.